Basic Information
| Provider Information | |||||||||
| NPI: | 1497867477 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE HO | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4580 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933091104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613274411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4580 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933091104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613274411 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A24547 | CA | Y | Allopathic & Osteopathic Physicians | General Practice | 208600000X | A24547 | CA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | A24547 | 01 | CA | LICENSE NO | OTHER |